Irish doctors oppose assisted suicide

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I was fortunate to have the opportunity to speak at the HOPE Ireland conference on Saturday, November 11, 2023. Ireland is currently debating the legalization of assisted suicide.

The Royal College of Physicians of Ireland (RCPI) recently explained their opposition to legalising assisted suicide in a presentation to the Oireachtas Committee on Assisted Dying.

The RCPI is Ireland’s largest post-graduate medical training body and a professional body for medical doctors with over 11,000 Members and Fellows across 29 different medical specialities in over 90 countries. 

The RCPI told the Oireachtas Committee that:

RCPI opposes the introduction of legislation for assisted suicide because it is contrary to best medical practice. Our view is that the potential harms outweigh the arguments in favour of legislation for assisted suicide.

The RCPI explained how legalizing euthanasia and assisted suicide have impacted other jurisdictions:

The impact of legislation for assisted suicide in countries where this has been enacted is now captured in an evolving body of evidence that can inform this committee’s work. I would like to mention the following:

Recent analysis of data from Netherlands, Belgium and Colombia confirms a progressive broadening of the limits initially established by the law for the practice of assisted death in these three countries. 

• There has been extension of age groups, to new-born infants in the Netherlands and to children over 12 in the Netherlands and children of any age in Belgium.
• A report published this week analysing the Oregon Death with Dignity Act confirms that eligibility criteria have expanded since the act was instated, with a 15-day waiting period requirement waived and patients receiving assisted suicide now including those with non-terminal illnesses such arthritis, arteritis, complications from a fall, hernia, sclerosis, ‘stenosis’ and anorexia nervosa.
• In Switzerland, assisted suicide is a legal option even for patients without suffering from a life-limiting disease, unbearable suffering and insufficient treatment options are the only criteria” A review published this month found that in Switzerland, from 2014-2018 the key criteria of “end of life is near” was only met in 43.6% of cases.
• In some jurisdictions, access to assistance to end one’s life has extended to those with psychiatric illnesses. Studies documenting experiences in the Netherlands cites many challenges in assessing irremediable psychiatric suffering. Despite this, 115 cases were recorded in there in 2021.
• Of 53 euthanasia case summaries published by the Dutch Regional Euthanasia Review Committees under the category Multiple Geriatrics Syndromes (example of which are visual impairment, hearing loss, pain, chronic tiredness), none suffered from life-threatening conditions – rather it was a “complex physical, psychological, and existential suffering that changes over time.”

The RCPI presentation refers to the recent report from Denmark's National Ethics Council which voted to oppose assisted suicide:

The risk of harm was considered by Denmark’s National Ethics Council. Earlier this month the Council rejected legalising Euthanasia. 16 of the 17 Council members emphasised that the presence of an offer of euthanasia risks decisively changing ideas about old age, the coming of death, quality of life. Once euthanasia becomes an option, they said, the risk that it will affect the view of certain groups in society is too great.

The RCPI responded to the concern around suffering:

There is much discussion around assisted suicide as a relief from intolerable pain. However other concerns appear to underly requests for assisted suicide. Oregon data for 2022 says that (as in previous years), the three most frequently reported end-of-life concerns were decreasing ability to participate in activities that made life enjoyable (89%), loss of autonomy (86%), and loss of dignity (62%), with inadequate pain control listed only 6th.

The RCPI concluded their presentation with the concern that safeguards fail:

One of our concerns is that any legislation cannot adequately safeguard vulnerable members of society. This is borne out in the Oregon data – there was a notable increase in the number of people citing being a burden on family and friends as among the reasons for requesting assisted suicide - from 30% in the first 5 years to around half since 2017. There was also an increase in the number of people citing financial concerns among the reasons.

A 2023 systematic review looking at assisted suicide among people with dementia has also noted that the wish for euthanasia/assisted suicide arises in situations of burdensome care and fear of future deterioration.”

More articles on this topic:

• Denmark's Ethics Council rejects legalising euthanasia (Link).
• Oregon's assisted suicide law - significant data gaps (Link).

Alberta United Conservative Party considers conscience rights for healthcare professionals

The Calgary Herald published the article: UCP policy proposals on MAID worth a second look by James Mahony on November 14, 2023.

By James Mahony

In a recent opinion column, Cynthia Clark attacks policy proposals on medical assistance in dying (MAID) presented at the recent United Conservative Party convention. It’s worth noting that, even if passed, these proposals might never be adopted by the Alberta government, or might be revised along the way.

Nonetheless, some of the proposals make sense, especially those protecting freedom of conscience for Alberta health-care professionals. Before discussing that, it’s worth touching on terminology. MAID is a euphemism for assisted suicide, coined by the Trudeau government in a bid to make the act socially acceptable.

Many Canadians opposed the legalization of assisted suicide and the common habit of describing it as medical care or treatment. In her column, Clark underscores what she terms the “vast” difference between encouraging a patients to end their life, and making them “aware of all the care options . . . available.”

The difference is not vast, but often quite subtle. That’s because those who are “informing” the patient typically include doctors whose strong influence over patient choices, including end-of-life choices, is undeniable. That’s without weighing the influence of pro-MAID doctors, who might not be shy about offering their opinions.

Describing assisted suicide as another “care option,” as if it were akin to antibiotic treatment, is simply misleading. It is state-sanctioned killing, albeit with the patient’s consent. As such, many doctors consider it morally wrong and refuse to provide or participate in it.

That brings us to freedom of conscience, something Clark says Alberta’s health-care workers, presumably including doctors, “already have” when it comes to MAID. Actually, they do not, at least not the kind of freedom of conscience that’s protected by law. On that score, Alberta MLA Dan Williams tabled Bill 207 intended to give them that right, which did not pass.

In Ontario, while not required to provide assisted suicide, doctors must make an “effective referral,” meaning referring the patient to a MAID-compliant doctor. In short, they must do indirectly what, for reasons of conscience, they will not do directly: facilitate assisted suicide. If they make such a referral, many Catholic and Christian doctors believe they are morally complicit in the patient’s death.

In Alberta, the situation is different: patients do not always rely directly on doctors to access assisted suicide. In effect, this frees Alberta practitioners from the dilemma facing their Ontario colleagues but offers no legal protection for those whose freedom of conscience might later be challenged on these or other grounds. There is still ample reason to enact an Alberta law protecting health-care professionals’ freedom of conscience.

Clark says it’s “not appropriate” to grant freedom of conscience to publicly funded institutions that might “impose” it on their employees. While she does not specifically name Catholic hospitals and facilities, it is mainly these that do not offer assisted suicide, a stance entirely consistent with their faith-based mandate: to respect human life at all stages, from conception to natural death.

Were Catholic health-care facilities forced to offer assisted suicide, as Clark implies they should be, one of two things would happen. Either they would willingly forfeit public funding and shut down rather than be complicit, or they would offer assisted suicide and cease being Catholic institutions. So far, governments have not forced Catholic hospitals to make that choice.

Many who enter Catholic hospitals and care homes do so by choice, knowing the institutions’ mandate. Many non-Catholics and non-Christians make the same choice, often for the life-affirming ethic that prevails in these facilities. When the going gets tough, as well it may, these patients know they will never be offered death as a so-called “treatment option.” That’s a relief for many Albertans.

American Medical Association retains opposition to assisted suicide

This article was published by National Review online on Nov 14, 2023.

By Wesley J Smith

Wesley Smith

I am a frequent critic of the medical establishment. But not this time. It didn’t make much news, but the American Medical Association had another vote to repeal its existing policy against assisted suicide, and for the fourth time — good on them — the delegates refused to budge.

The current policy remains in place, which states in part:

Euthanasia is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.

Euthanasia could readily be extended to incompetent patients and other vulnerable populations.

The involvement of physicians in euthanasia heightens the significance of its ethical prohibition. The physician who performs euthanasia assumes unique responsibility for the act of ending the patient’s life.

Instead of engaging in euthanasia, physicians must aggressively respond to the needs of patients at the end of life. Physicians:
(a) Should not abandon a patient once it is determined that a cure is impossible.
(b) Must respect patient autonomy.
(c) Must provide good communication and emotional support.
(d) Must provide appropriate comfort care and adequate pain control.

The AMA also refused to change the descriptive and accurate term “assisted suicide” to the euphemistic “medical aid in dying.”

Article: American Medical Association maintains opposition to assisted suicide (Link). 

American Medical Association maintains opposition to assisted suicide

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Great news: The American Medical Association (AMA) upheld their opposition to assisted suicide and euthanasia.

This is a huge win as AMA delegates voted down the attempt to change the code of ethics to support or become neutral on assisted suicide and they voted down the attempt to change terminology from assisted suicide to Medical Aid in Dying (MAiD). 

The take home message is that medical professionals, young physicians and medical students must be involved in the AMA.

On October 10, the Euthanasia Prevention Coalition (EPC) were the first group to report that the AMA would be debating their policies on assisted suicide and euthanasia at the AMA House of Delegates interim meeting in Maryland (November 10 - 14, 2023).

50 draft resolutions were proposed with two of the draft resolutions dealing with assisted suicide and euthanasia.

• Resolution 4 proposed to change the position of the AMA from opposition to supporting (Resolution Link).
• Resolution 5 was for the AMA to adopt a neutral stance. (Resolution Link).

Resolution 4 would have  removed the AMA statement on not performing euthanasia or participating in assisted suicide. Both resolutions proposed to change the terminology from Physician-Assisted Suicide to Medical Aid in Dying (MAiD). The term Medical Aid in Dying includes assisted suicide and euthanasia.

Thank you to the many medical professionals who responded to the alert and worked to defeat Resolutions 4 and 5.

Michigan debates deceptive assisted suicide Senate Bill 0681

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Michigan assisted suicide Senate Bill 0681 is similar to previous versions of the Oregon assisted suicide law. Senate Bill 0681 is a tighter assisted suicide bill which tells me that the assisted suicide lobby doesn't have the votes in Michigan.

Senate Bill 0681 is a "trojan horse" as it is designed to sell assisted suicide and if passed  the assisted suicide lobby will soon expand the law.

The Oregon assisted suicide law is promoted as having safeguards, in fact the law lacks any effective oversight.

What you need to know about the Oregon assisted suicide law

The 2022 Oregon assisted suicide report indicated that there were 278 reported assisted suicide deaths up from 255 in 2021. There were 431 lethal death prescriptions up from 383 in 2021.

The 2022 report indicates that even though there were 278 reported assisted suicide deaths, there were an additional 101 deaths where ingestion status was unknown. When the ingestion status is unknown, the person received the lethal drugs and died but there is no information as to whether the person died by assisted suicide or by a natural death.

As with previous years, the report implies that the deaths were voluntary (self-administered), but the information in the report does not address that subject.

The assisted suicide lobby, for political reasons, has decided to introduce an older style Oregon assisted suicide bill in Michigan, but once legal they will move to expand the law.

Expansion of assisted suicide

Oregon Governor Kate Brown, in July 2019, signed Bill SB 0579 into law which essentially eliminated the 15 day assisted suicide waiting period by allowing the physician to waive the waiting period. If the patient is depressed, the patient loses the opportunity to change their mind.

The physician waived the 15 day waiting period in 109 assisted suicide deaths in 2022. In some cases the lethal drug cocktail was ingested the day after the first request.

Oregon has removed the assisted suicide residency requirement

A story published in the Daily Mail stated that an assisted suicide clinic in Oregon has started doing assisted suicide for out-of-state residents (suicide tourism). The Daily Mail reports:

Oregon has become America’s first ‘death tourism’ destination, where terminally ill people from Texas and other states that have outlawed assisted suicide have started travelling to get their hands on a deadly cocktail of drugs to end their lives, DailyMail.com can reveal.

In the liberal bastion Portland, at least one clinic has started receiving out-of-staters who have less than six months to live and meet the other strict requirements of the state’s Death with Dignity (DWD) law.

Dr. Nicholas Gideonse, the director of End of Life Choices Oregon, recently told a panel that he was advising terminally ill non-residents on travelling to Oregon to end their lives, despite a legal gray area.

The assisted suicide lobby, over the past few years, has expanded existing assisted suicide laws. Oregon has eliminated their reflection period and their residency requirement. Vermont is permitting assisted suicide by telehealth and have eliminated their residency requirement, Washington state, California and Hawaii also expanded their assisted suicide laws. New Mexico has the most extreme assisted suicide law in America.

Assisted suicide drug experimentation

Assisted suicide activists have been experimenting with lethal drug cocktails on people approved for assisted suicide. An article by Lisa Krieger published by the Medical Xpress on September 8, 2020 uncovers information about the lethal drug experiments:

A little-known secret, not publicized by advocates of aid-in-dying, was that while most deaths were speedy, others were very slow. Some patients lingered for six or nine hours; a few, more than three days. No one knew why, or what needed to change.

"The public thinks that you take a pill and you're done," said Dr. Gary Pasternak, chief medical officer of Mission Hospice in San Mateo. "But it's more complicated than that."

Assisted suicide is sold to the public as offering a peaceful death. Assisted suicide is far more complicated than that.

The 2021 Oregon report emphasizes that the use of the fourth generation of lethal drug cocktails show that the length of time to die has reduced but the problems with the lethal drug cocktail experiments continue.

The yearly Oregon DWD reports are based on data from the physicians who prescribe and carry-out the assisted suicide deaths. The data is not independently verified. 

 

Data concerning complications and length of time for death, etc., can only be reported when a healthcare provider is present at the death. Information from Oregon concerning complications is only available for 150 of the 278 reported assisted suicide deaths in 2022. For the other 128 assisted suicide deaths, no information is known about the death.

The assisted suicide lobby claims that Oregon has a "safe" assisted suicide regime but in fact the Oregon law lacks effective oversight. 

A recent report published in the British Medical Journal Supportive and Palliative Care examines the data from the Oregon Death with Dignity reports (1998 to 2022) and uncovers significant problems with the Oregon assisted suicide data.

Don't let the trojan horse of assisted suicide Senate Bill 0681 into Michigan.

Once assisted suicide is legal, the assisted suicide lobby will lobby or launch court cases to expand the law. The original assisted suicide bill is designed to pass in the legislature, once passed incremental extensions will follow.

"Completed Life" debate in the Netherlands. Assisted suicide based on being 75

This article was published by National Review online on November 10, 2023.

Wesley Smith

By Wesley J Smith

Once a society embraces killing as an answer to suffering, the “suffering” that qualifies for termination never stops expanding.

The Dutch have decades of experience with this. Since lethal-injection euthanasia became decriminalized — and then, formally legalized — the killable caste has expanded from the terminally ill, to the chronically ill, to people with disabilities, to babies born with serious medical conditions, to the mentally ill, etc., etc., etc. And, as a plum to society — and an inducement to be killed — euthanasia is sometimes conjoined with organ harvesting.

The normalization of medical homicide corrupts people’s thinking, which explains why huge majorities in a Dutch poll now support allowing euthanasia for a “completed life.” From the NL Times story:

Voters are much more progressive about the D66 bill to allow assisted suicide for people who feel their life is complete than the political parties themselves. A massive 80 percent of voters believe that people should be able to get help in dying when they feel they’ve come to the end of their life, Trouw reports based on a Kieskompas poll of almost 200,000 people.

Only 10 percent of respondents disagreed with the statement that people who consider their lives complete should be able to end their lives with professional help. The other 10 percent of voters had no opinion on the matter.

The first focus of this idea are the elderly:

The bill would allow people over 75 to decide when to die with professional help if they feel they’ve reached the end of a completed life. Added to the bill is a six-month process in which they have to meet with an “end-of-life counselor” at least three times.

Note well that the concept of the “completed life” need not involve any physical illness, disabling condition, or psychiatric malady at all. It could include loneliness, boredom, fear of future widowhood — joint-euthanasia killings of ill spouses are allowed in the Netherlands (also Belgium and Canada), death of an adult child, you name it. In other words, “completed life” euthanasia would allow the healthy elderly to be terminated.

And why should eligibility be age-directed? Once the concept of the “completed life” is accepted, why not open the death option to younger people? Indeed, doesn’t every suicidal person believe their life is completed? In theory, there is no limiting principle.

Euthanasia corrupts public morality and the human conscience. The same progression into the culture of death will happen here if we don’t resist the siren song of “death with dignity.” It’s only logical.

Those with eyes to see, let them see.

Canada: Women, the lonely, and people with disabilities, at risk to euthanasia

This article was recently published by the Australian Care Alliance.

Article: Health Canada reports 13,241 assisted deaths in 2022 representing 4.1% of all deaths (Link).

In October 2023 the Fourth Annual Report on Medical Assistance in Dying in Canada was published. It stated that there had been 13,241 reported cases of euthanasia and assisted suicide in 2022, bringing the total of such deaths since legalisation to 44,958.

The number of cases each year has more than quadrupled (466%) in 6 years from 2,838 in 2017, the first full year of legalisation, to 13,241 in 2022 with annual increases of 57.8% (2018); 26.4% (2019) 34.2% (2020); 32.4% (2021) and 31.2% (2022).

“Fewer than seven” cases of assisted suicide have occurred each year since 2019. Canadian practice overwhelming uses euthanasia. The 2019 report stated that: “providers are less comfortable with self-administration [assisted suicide] due to concerns around the ability of the patient to effectively self-administer the series of medications, and the complications that may ensue”.

In 2022 euthanasia and assisted suicide accounted for 4.1% of all deaths in Canada. Provincial rates of euthanasia are highest in Quebec - 6.6% in 2022 and British Columbia - 5.5% in 2022.

Underlying conditions

Very limited data is provided on the “main condition” for which euthanasia is performed.

In 2022, for 8.3% of cases the “main condition” is reported as “multiple comorbidities” and a further 14.9% as “other conditions” - that is other than cancer, cardiovascular, respiratory, neurological or organ failure. For these two categories combined, 25% of cases involved “frailty” and 11.9% involved diabetes. Other conditions cited included vision or hearing loss, tendency to falls; and difficulty swallowing. For women these two categories now account for nearly one out of three (29.1%) deaths by euthanasia.

The 2021 report comments “Multiple comorbidities and other conditions encompassed a wide range of diseases or conditions, including frailty, diabetes, arthritis, and osteoporosis”. Note that these are not terminal conditions.

In only 161 cases in 2022 did the clinician administering euthanasia give their specialty as oncology. Additionally, 806 cases involved some consultation with an oncologist. This means that in 2022, at least 7,649 Canadians were euthanized on the basis that they had cancer with no discussion with an oncologist about this course of action. This represents 90.6 % of cases of euthanasia for cancer.

The majority (67.7%) of those administering euthanasia were primarily engaged in family medicine.

The 2022 report notes that the second opinion on eligibility was given by a nurse practitioner in 7.3% of cases.

“Death be reasonably foreseeable” - no longer required

The Canadian law initially required that “death be reasonably foreseeable”. The decision of the Ontario Superior Court of Justice in AB v Attorney General of Canada delivered on 19 June 2017, in paragraph 81, interpreted this requirement as not requiring any connection whatsoever between the underlying conditions for which euthanasia is sought and the reasonable foreseeability of death – which can be based simply on advanced age. The woman in this case was 79 years old.

On 11 September 2019, the Quebec Superior Court, in the case of Truchon c. Procureur général du Canada, invalidated the relevant provisions in the Canadian law which limited euthanasia to cases where “natural death has become reasonably foreseeable” and the Quebec law which required that the person be “at the end of life”. The effect of this decision was suspended for six months.

The Canadian Government introduced Bill C-7 into the House of Commons in February 2020 to give statutory effect to the decision. The Bill became law from 21 March 2021 opening the way for euthanasia to be given to people with chronic, non-terminal conditions, including people with a disability.

463 such cases were reported for 2022. -59% of these involving the euthanasia of a woman whose death was not reasonably foreseeable.

In Ontario in 2022, 121 out of 3934 (3.1%) euthanasia cases involved a person whose natural death was not reasonably foreseeable.

Short time between initial request and euthanasia being performed

Section 241.2 (3) (g) of the Canadian Criminal Code required a physician to “ensure that there are at least 10 clear days between the day on which the request was signed by or on behalf of the person and the day on which the medical assistance in dying is provided or — if they and the other medical practitioner or nurse practitioner referred to in paragraph (e) are both of the opinion that the person’s death, or the loss of their capacity to provide informed consent, is imminent — any shorter period that the first medical practitioner or nurse practitioner considers appropriate in the circumstance”.

Of the 7,384 people killed by euthanasia in Canada in 2020 for whom data is available on the length of time between first request and when euthanasia was administered some 34.3% or 2,532 people were euthanased in less than 10 days of first requesting it.

For 905 of these people the only justification given for the haste with which euthanasia was performed was that loss of capacity to consent was imminent. This raises real questions about the validity of the original request. If a person is on the verge of losing capacity what degree of certainty can there be that the person currently has full capacity?

In the period April 2021 to March 2022 in Quebec, 50% of people were euthanized less than 10 days after making a request. However, only 13% of people had a prognosis of less than 2 weeks to live.

Under the revised law from 21 March 2021 there is no longer any required waiting period for any person whose death is said to be “reasonably foreseeable”. Same day request and lethal injection is acceptable.

In other cases, a 90 day waiting period is specified but if the two assessing practitioners think that loss of decision making capacity is imminent this can be waived entirely.

Advanced directive

Euthanasia can now (since 21 March 2021) be provided on the basis of an advanced directive to persons who have lost decision making capacity. This is not supposed to be done if the person resists or refuses by "words, sounds or gestures".

However, this requirement is undermined by a provision that "involuntary words, sounds or gestures made in response to contact do not constitute a demonstration of refusal or resistance". How do we know they are "involuntary"?

In Ontario in 2022, 190 out of 3934 (4.83%) involved euthanasia of a person who at the time they were killed was incapable of giving consent.

Reasons for requesting euthanasia

The 2022 annual report states that loss of ability to engage in meaningful life activities (86.3%) followed closely by loss of ability to perform activities of daily living (81.9%) were the most common reasons for a euthanasia request.

Inadequate control of pain, or concern about it (59.2%) ranked much lower.

Disturbingly 35.3% reported as a reason for their euthanasia request “Perceived burden on family, friends or caregivers” and 17.1% reported “Isolation or loneliness”.

So in 2022 some 2,294 Canadians were given a lethal injection because they were lonely: Why didn't the doctor or nurse practitioner just have a cup of tea and a chat with them instead of giving them a lethal injection?

For Quebec, between April 2021 and March 2022, 1700 (47%) of people euthanased gave a reason as “Perceived burden on family, friends or caregivers” and 824 (23%) of people reported “isolation or loneliness” as a reason.

Needed disability services and palliative care not provided

In 2022 there were 328 cases where palliative care was not accessible if needed – an increase of 63% from 2021 when cases had already increased by 60% from the 126 cases in 2020.

The 2021 report notes even where palliative care was being accessed or was available “this result does not offer insight into the adequacy or quality of the palliative care services that were available or provided”.

In 2022 there were 568 cases where disability support services were needed but NOT received (up from 332 in 2020 – an increase of 71%). In 2021 this included 12 of the 219 people whose deaths were “not reasonably foreseeable”.

The 2020 report stated that “Disability support services could include but are not limited to assistive technologies, adaptive equipment, rehabilitation services, personal care services and disability based income supplements.” The 2021 report admits that, even for those who were reported as having received disability support services, the data “does not provide insight into the adequacy of the services offered”.

Denied assisted living but offered assisted suicide

Roger Foley, who has a crippling brain disease, has been seeking support to live at home. He is currently in an Ontario hospital that is threatening to start charging him $1,800 a day. The hospital has told Roger that his other option is euthanasia or assisted suicide under Canada’s medical assistance in dying law.

Candice Lewis: pressure for euthanasia based on disability

Candice Lewis (right)

Candice Lewis was a 25 year old Canadian woman who happened to have cerebral palsy.

In September 2016 Candice went to the emergency room at in Newfoundland after having seizures.

The doctor told her she was very sick and likely to die soon. He offered her assisted suicide. The doctor also proposed assisted suicide for Candice to her mother Sheila Elson.

This offer was repeated despite both Candice and her mother making it clear that this was not an option Candice would consider. The doctor told Sheila she was being selfish by not encouraging her daughter to choose assisted suicide.

Candice describes how bad it made her feel that a doctor was offering her assisted suicide.

More than twelve months later Candice had recovered well and her health was much improved. Candice wasn’t having any seizures, was now able to feed herself, walk with assistance, use her iPad. She was more alert, energetic and communicative. She was able to walk down the aisle as a bridesmaid at her sister’s wedding in August 2017. She was doing what she loved most, painting and being with her family.

Candice and her mother Sheila were interviewed by Kevin Dunn, who is produced a film on euthanasia and assisted suicide called Fatal Flaws for the Euthanasia Prevention Coalition. The film of the interview can be viewed here.

Candice has since passed away from natural causes.

There are several take home lessons from Candice’s experience:

• Doctors can get the prognosis wrong. Candice was told she was dying but is flourishing twelve months later. A wrong prognosis can lead to assisted suicide or euthanasia. A life can be thrown away needlessly;
• People with a disability already suffer discrimination in health care. When assisted suicide and euthanasia are legal, people with a disability are more at risk of being offered death as a solution because doctors and others consider that they would be better off dead;
• Once doctors are authorised by the law to provide assisted suicide and euthanasia some of them will feel empowered to offer it to anyone they think would be better off dead. This undermines patients’ trust in doctors and can cause great distress.

A taste for killing?

Of the 1746 physicians and 91 nurse practitioners who euthanased people in 2022, some 336 of them did so 10 times or more – up 29.2% from 260 in 2021. The 91 nurse practitioners killed an average of nearly 14 people each – twice the average for medical practitioners of 7 people each.

Conclusion

Canada's court ordered experiment with euthanasia is already out of control with significant rates of failure to comply with the legal requirements and processes. No action appears to have been taken in response to identified cases in which euthanasia is performed contrary to the law. People with disabilities are being harassed to choose assisted suicide against their will.

Government of Jersey Assisted Dying report calls for a law with tight restrictions

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I am currently in the UK on a speaking tour and will be speaking in Jersey on Thursday November 9. Today the government of Jersey released its assisted dying ethical review, a report from the Minister for Health and Social Services.

The research for the report is based on three "specialist witnesses" - Professor Richard Huxtable, Professor Trudo Lemmens, and Dr. Alex Mullock.

The Government of Jersey has indicated that they will likely begin the debate on euthanasia and assisted suicide by the end of summer 2024.

The Euthanasia Prevention Coalition opposes euthanasia and assisted suicide because these acts require one group of people (usually physicians) to be involved with killing people.

BBC news reported:

Adults in Jersey seeking AD eligibility fell into one of two categories; those who are "terminally ill", and those with "unbearable suffering".

The experts, after taking many reasons into account, concluded that proposals for AD for those with a terminal illness were "ethically appropriate".

However, they had "serious reservations" about allowing AD for those with "unbearable suffering", deeming the term too vague.

They concluded AD proposals in such circumstances, "are not ethically appropriate."

The experts are correct that the term "unbearable suffering" cannot be defined and approving killing based on "unbearable suffering" will inevitably lead to expansions of the law, the same problem also exists with the term "terminal illness." Some jurisdictions have defined terminal illness as having a six month prognosis, but that is difficult to define.

For instance, an insulin dependent diabetic who decides to stop using insulin will be defined as terminally ill even though that person has a medical condition that is effectively treatable.

The BBC reported that the experts rejected the option of suicide tourism by finding that euthanasia and assisted suicide should only be available to Jersey residents. The experts supported the right for medical professionals to conscientiously object to participating in euthanasia and assisted suicide.

ITV news provided a little more information on the recommendations. ITV news reported:

It says the term "unbearable suffering" is too vague and too open to interpretation - since physical conditions and tolerance of pain can fluctuate over time and can improve with the right treatment.

“Incurability may be hard to define, and ‘intolerability’ will rest on subjective judgements", Professor Huxtable wrote.

The ethical review also suggested that this "route" to assisted dying may undermine the value of disabled people’s lives - and would risk expanding the scope of the law beyond what was intended.

The review panel states: "Incurability may be hard to define, and ‘intolerability’ will rest on subjective judgements, which may mean the patients seek and receive assisted dying without having tried viable options, which doctors may find difficult and which may mean it becomes more difficult to restrict the practice."

Professor Huxtable cites Canada as an example of a "slippery slope" where more and more people may be eligible for assisted dying when there are other treatment options available to them.

The review only supports allowing Jersey residents to end their own lives, to avoid the island becoming a "death tourism" destination.

It asks politicians to consider a minimum term of residency before someone becomes eligible.

It also states more robust testing is needed to determine whether or not someone is cognitively able to make the decision on whether to end their own life.

The review recommends that patients be required to self-administer the drugs to end their lives to protect them and put them in control by confirming it is genuinely their wish.

An appeals process was also suggested, allowing those with a legitimate interest to raise a legal challenge.

Professor Huxtable said this would increase public confidence and address concerns about "medicalising" the issue.

This report is flawed because it examines how to kill rather than if it is ethical to kill people at all. All the ethical reports based on legalizing the killing only debate the question of who we can kill and who should do the killing. Once legalized the question will change to whether it is discriminatory to continue to restrict the killing to certain groups or conditions.

The killing inevitably opens to more conditions for killing and more people who can kill.

Pennsylvania nurse linked to 17 nursing home deaths

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A Pennsylvania nurse proves why you cannot trust every medical professional with your life.

Jon Haworth reported for ABC news on November 3, that:

A former Pennsylvania nurse who, in May, had been accused of killing two patients with doses of insulin, now faces more murder charges. She has confessed to trying to kill 19 additional people at several locations, authorities said Thursday.

Heather Pressdee, 41, is accused of administering excessive amounts of insulin to patients in her care, some of whom were diabetic and required insulin, and some of whom were not, according to the Pennsylvania Attorney General’s Office.

In total, 17 patients died who had been cared for by Pressdee.

According to Haworth, Pennsylvania's Attorney General's Office stated:

"The allegations against Ms. Pressdee are disturbing. It is hard to comprehend how a nurse, trusted to care for her patients, could choose to deliberately and systematically harm them,” said Pennsylvania Attorney General Michelle Henry. "The damage done to the victims and their loved ones cannot be overstated. Every person in a medical or care facility should feel safe and cared for, and my office will work tirelessly to hold the defendant accountable for her crimes and protect care-dependent Pennsylvanians from future harm."

Pressdee has now been charged with 2 counts of first-degree murder, 17 counts of attempted murder and 19 counts of neglect of a care-dependent person.

Haworth reported that The Attorney General's Office stated that:

"The alleged crimes happened while Pressdee was employed as a registered nurse at the following facilities: Concordia at Rebecca Residence; Belair Healthcare and Rehabilitation (Guardian); Quality Life Services Chicora; Premier Armstrong Rehabilitation and Nursing Center; and Sunnyview Rehabilitation and Nursing Center," officials said. "Pressdee typically administered the insulin during overnight shifts when staffing was low and the emergencies would not prompt immediate hospitalization."

The victims ranged in age from 43 to 104.

Similar to the Elizabeth Wettlaufer murders in London and Woodstock, Ontario Canada, the crimes occurred over several years and there was minimal oversight over the medications at the care homes. Similar to the Wetlaufer case, the news article related to the original charges in May 2023 stated that:

The complaint states that Pressdee has an alleged pattern of "being disciplined for abusive behavior towards patients and/or staff" at several other facilities and either resigned from them or was terminated.

Both Wettlaufer and Pressdee received serious complaints against them and were either fired or resigned their positions. But they were still able to find employment as nurses in other facilities.

During the Wettlaufer trial in Canada, I stated that the deaths were only a tip on the iceberg based on the lack of oversight and the vulnerability of those who were killed. My position remains the same. There may be many more murders occurring in care homes throughout Canada and the USA.

Canada's euthanasia law lacks the same type of oversight. In Canada a person is approved to be killed when two doctors or nurse practitioners agree that the person qualifies. The law only requires that the doctors and nurse practitioners be of the opinion that the person meet the criteria of the law. In other words, there is no effective oversight of the law and yet 13,241 Canadians reportedly died by euthanasia in 2022.

An unapologetic recommendation of absolute prohibition on killing: the stopped clock

By Gordon Friesen

President, Euthanasia Prevention Coalition

Gordon Friesen

As Lewis Carroll once pointed out,  a stopped clock is right twice a day. But a clock which loses only one minute in twenty-four hours will be right only once in two years.

Like the stopped clock, the multi-millennial moral precept "Thou shalt not kill", is a simple blunt instrument with no moving parts. Easy to understand. Generally easy in application. Its principal benefit (and over-arching civilizational significance) is that it points clearly to an absolute moral conclusion: killing of any sort (including killing of oneself) is wrong. Full stop.

Unfortunately however, in the complexity of human life, situations necessarily arise, where such invariable conclusions lead to apparent injustice. The idea becomes very appealing, therefore --for legislators as for watchmakers-- to seek ever-more subtle mechanisms, which will enable more finely adapted judgments, in more cases.

But in this pursuit, the watchmaker has a huge advantage over his legislative counterpart: being the fact that he is able to verify the accuracy of his work, through direct observation (of the sun, or other time-reliable phenomena). For the lawmaker, on the other hand, it is the intellectual and spiritual crisis of our time, that there exists no such agreed higher standard, which might allow us to effectively verify, and reset, our moral bearing; and should our complex post-modern legislative construct go slightly out of whack (like the minimally slowing clock), we have no means to verify or correct that fact.

In other words: once simple moral maxims are set aside, subtlety in judgment will be inversely proportional to shared agreement on the justice of those judgments.

Moral simplicity is not always bad

Today, for instance, there is a tendency to examine, not the act, but the intent. In this view, the act of killing, itself, has no moral attribute. Killing may be right or wrong depending on why it is done.

And perhaps that might be true for a perfectly informed, perfectly disinterested, ideal intelligence. But in the real world, such thinking immediately leads to subjectively indulgent attempts, to morally justify acts, which just happen to coincide with the personal interests of the perpetrator.

In a simpler time, on the other hand, it was assumed (however problematically) that there might be exceptions to a rule, without invalidating its core meaning. An aggressor, for example, might be killed in self-defence, but that killing, although understandable, was still considered a regrettable wrong.

This in no way solves the problem of agreeing on which exceptions are legitimate, and in which cases; but it does impose a certain solemnity of deliberation, when compared to the nonchalance of admitting, from the start, that there is nothing intrinsically wrong about killing.

It is a very significant fact, I submit, and too often ignored by clever social theorists, that in spite of our post-modern philosophical malaise, the vast majority of people still instinctively think, feel, and behave in this manner.

Advocates of assisted death are therefore faced with a strong social discomfort before the facts of suicide, and homicide. And to the extent that relativist arguments have proved insufficient to counter this bias, they have undertaken to perpetrate a direct assault on the foundations of common language, and understanding.

When killing is not killing

With astounding simplicity it is declared (and in my country, decreed, with the full force of parliamentary power) that euthanasia is a positive "good".  And since "killing" is universally considered to be "bad" (regardless of intent), it therefore follows (by definition) that euthanasia (although technically identical in every respect) is not killing.

There may be a small satisfaction in remarking the complete rational bankruptcy of such a position --similar to that of a small child who covers his own eyes in order to become invisible-- but that satisfaction in no way compensates for the vandalism incurred.

Most importantly, as with our touchingly deluded child, wilfully ignoring the basic facts of assisted death --whether assisted suicide or euthanasia-- does not make the deeper social implications of those practices go away.

Examining our three options, side by side...

First of all, the absolute prohibition of homicide (including the killing of oneself) implies an affirmation that life must be protected. This shared conviction offers the greatest support, both internal and social, for all those who are struggling on the cusp of existential despair. It does not make the universal relief of suffering any more immediately possible, but it does imply a constant civilizational effort (and hence a reliably constant progress) towards that goal.

Secondly, The simple social permission of suicide, including assisted suicide, is postulated upon the idea that for some people, in some circumstances, life is simply not worth living. But from this first theoretically admitted exception, the practical bar of application is arbitrarily lowered, through a general liberty of autonomous subjective choice. In the end, therefore, the threshold of "intolerable suffering" is set by the most marginal suicidal wish among us. And the despair, of that one, is allowed to justify and to nourish the despair, of all others.

In third place, the justification of assisted death as a positive medical benefit (objectively appropriate for the treatment of suffering in defined clinical situations), leads directly to a pseudo-scientific crusade, aimed at the elimination of all defective (suffering) life. For in the Canadian view, deaths by euthanasia (in keeping with the Greek etymology) are literally "good" deaths. And the promotion of such deaths thus becomes, itself, a worthy goal.

Furthermore, since death is now embraced as a simple and infallible cure, there will quite naturally be less perceived urgency, in any other relief of present suffering, or in any committed social effort to improve the means of that relief.

And again, since both the social acceptance of suicide, and that of euthanasia, imply that there is no intrinsic value in preventing death, these phenomena are rooted in a philosophy which is optimally suited to validate suicidal desire and despair; and to validate the self-perception of those few who --for whatever reason-- abandon themselves to those forces.

The "stopped clock" of the absolute prohibition of homicide, on the other hand, is optimally suited to socially sustain the efforts of that majority who will ultimately choose to survive. And since it is these survivors (and perhaps their descendants) who alone intend to live, in the future world governed by present policy, it is my belief, that their interest should be given far greater weight, than that of their more ambivalent counterparts.

The best choice: simple prohibition

Clearly there is no easy solution. We must weigh the scale of comparative harms.

Is it really so egregious, that a few people be asked to live a little longer, in order to unambiguously protect the lives of those --much more numerous-- who do not wish to die or be killed?

To conclude, it is my sincere belief that jurisdictions studying the assisted death question need not allow themselves to fall into the trap of that curious (but uncommitted) potential customer, who has allowed the clever salesman to impose a choice between the red one, and the blue one.

On the contrary, there is no urgent necessity to make any choice at all. The current, time-tested, absolute prohibition of homicide (including assistance to suicide) carries much less social hazard than either the Canadian, or the Swiss model, of assisted death.

Gordon Friesen, Montreal

1. "The two clocks", from Further Nonsense Verse and Prose, Lewis Carroll, posthumous, 1926   https://archive.org/details/further-nonsense-verse-and-prose/page/90/mode/2up   accessed Nov 5, 2023

Globe and Mail editorial urges federal government to withdraw euthanasia for mental illness

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Globe and Mail editorial from November 4 urges the federal government of Canada to withdraw the expansion of euthanasia for mental illness.

The editorial comments on the 2022 Health Canada euthanasia report indicated that 13,241 people reportedly died by euthanasia in Canada, with Quebec having the highest euthanasia report in the world. The editorial quotes Quebec officials who are concerned that euthanasia is no longer a "last resort."

Dr. K Sonu Gaind

The editorial quotes Dr. K Sonu Gaind, Chief of Psychiatry at Sunnybrook Health Sciences Centre in Toronto, who consistently states that there is "absolutely no consensus" as to what constitutes an irremediable medical condition when it comes to patients with mental illness. This is important because the law requires that a person only be approved for euthanasia if they have an irremediable medical condition. 

The editorial states:

However, Canada's framework for approving a medically assisted death for someone suffering from a mental illness does not require that a trained psychiatrist make an evaluation. Instead, doctors (with some expertise) are expected to make a case-by-case detemination. even when those with decades of experience are flummoxed.

A delay until March is not enough; Ottawa needs to withdraw it's amendments that include mental illness in the law for MAiD. There are too many uncertainties, most crucially the inability to determine who is suffering from a truly irremediable mental disease and who will recover given enough time, treatment and hope.

Previous articles from K Sonu Gaind (Articles Link).

HOPE Ireland Conference - Saturday November 11, 2023

Register for the HOPE IRELAND Conference on Saturday November 11, 2023. (Registration Link)

We are very pleased to announce that our Living and Dying with Dignity Conference will take place at the Dublin Chamber of Commerce on Clare Street on Saturday 11th November from (11 am until 3 pm). (Information Link)

Speakers will include:

• Alex Schadenberg
• Professor Des O'Neill
• Dr. Miriam Colleran
• Dr. Gordon MacDonald

Alex Schadenberg

The event will be headlined by Alex Schadenberg.

Alex is one of the world’s premier opponents of euthanasia and assisted suicide. He is the co-founder and executive director of the Euthanasia Prevention Coalition, founded in 1998 and based in Canada.

Des O'Neill is Professor of Medical Gerontology in Trinity College Dublin. He was the first medical director of the Alzheimer Society of Ireland.

Dr. Miriam Colleran is Consultant in Palliative Medicine in Naas General Hospital.

Dr. Gordon MacDonald

Dr. Gordon MacDonald is Chief Executive of Care Not Killing, an Alliance of organisations that oppose assisted suicide and euthanasia.

Seating is limited, if you wish to attend the event please take a moment to register instantly today using the button below. (Registration Link).

Kind Regards,
Siobhán Traynor